20 September 2019

The International Council of Nurses (ICN) shares its perspective on how nurses play a vital role in achieving universal health coverage.

International Council of Nurses: why nurses are so important for UHC

From the perspective of Annette Kennedy, President of ICN

“ICN, representing more than 20 million nurses worldwide considers that health care is a human right for everyone; not just health care but quality affordable timely and accessible health care. The country or place where a woman lives should not dictate whether she lives or dies because she cannot afford health care or it is not accessible. Neither should a child die from malnutrition or infectious diseases because of where he or she is born. A heath care worker should not die because they work in countries where there is insufficient heath care resources to offer them appropriate protection while caring for patients in high risk environments such as fighting Ebola.   

“Nurses make up nearly half of the world’s healthcare workforce and deliver almost 80% of the hands-on care. They are often the first healthcare staff to interact with patients and sometimes the only health professional a patient will ever see. They provide care, support and treatment for the sick, the injured and the dying and support their families and communities. They detect illnesses, administer medicines, assist in surgeries, treat patients beyond the initial diagnosis, provide mental support and perform any number of other key roles. Hence, nurses are intrinsically linked to a country’s ability to address health priorities.

“Nurses are at the heart of the world’s current health priorities, from fighting non-communicable and infectious diseases via tackling the rise of antimicrobial resistance, to addressing health emergencies and stemming pandemics. So, for the goal of Universal Health Coverage (UHC) by 2030 to remain tangible, countries need to invest heavily in the nursing profession now and into the future.

“Nurses also have to be all things to all people. Now, with advanced practice, they are at a level where they can diagnose, prescribe and treat patients. It’s not widely understood that nurses are educated to degree, masters and PhD levels and in many countries around the world nurses are doing extraordinary work to treat patients. Civil society and even our own partners in health care probably don’t understand or recognize the important work that nurses do. 

“Over the past three years, for International Nurses Day, ICN has collected case histories of nurse-led services and achievements throughout the world. It made us realize that nurses have to be very creative and innovative in order to provide health and nursing care to the most vulnerable people in society, those most in need and those in remote and difficult to reach areas. What has impressed me more than anything is the way that nurses, despite the challenges they face, can expand, twist and contract their roles in creative and ingenious ways to match patient circumstances. 

“This year’s case histories have focused on UHC and provide some very interesting perspectives on nursing. For example, nurses in Uganda are in villages teaching basic health tips relating to sanitation and hygiene, like washing hands, boiling water, cleaning the house and removing stagnant water where mosquitos might breed. All this is so important to health. The nurses build a relationship with a community and local village workers which works very well. It is small but it is something that makes a difference. In the USA, nurses are partnering with social workers and developing community relationships in relation to people who are homeless, who suffer from addiction or who have been incarcerated in prison and have no access to health facilities on release.  

“From the information ICN has picked up in our case histories it is clear the world needs to focus more on primary health care (PHC). Heath care spending is largely given to tertiary care in high-income countries and generally the greatest percentage of health care is given to the last five years of life. This is to the detriment of primary care with very little emphasis on health promotion, disease prevention and early intervention. However, there are many great examples of nurses going to areas where they can reach out and assess patients at the primary care level. For example, in the USA, nurses are going into the Appalachian Mountains where people probably cannot afford health care and have very poor or no health insurance. Patients are not going for treatment until they are very ill with many complications. Nurses have gone out to these remote areas and provided assessment clinics for blood pressure, diabetes and other non-communicable diseases. Savings of US$4 billion are estimated because the number of people going into A&E has declined from between 19-24%. The results of this early intervention give people a longer and better quality of life.

“The growing epidemic of non-communicable diseases (NCDs) has dramatically overtaken the infectious diseases epidemics; an extraordinary 75% of all deaths are caused by NCDs (respiratory, cardiovascular, cancers, diabetes, and mental health). Much of this is preventable or at the very least, early treatment will give people twenty additional years of better quality life. We must change our model of care from curative to prevention and from hospital to primary care. Lower and middle-income countries must not replicate what has been done in higher income countries as it will not serve countries well in their efforts to implement UHC.

“Primary care is an area where nurses can make a significant difference as they are based in the community and work with families, educators and community groups. Nurses know the patients, their families their support structures their health needs, personal and financial issues. Nurses know the services available and those that are lacking; in other words nurses have a holistic view not just of the patient but of the service. Who is better placed to inform health policy? But in order to inform health policy nurses need to be at the policy table. 

“In recent years, ICN has certainly been proactively working with many of the global agencies like WHO, ILO, UN and women’s organizations like Women Deliver and of course our partner Nursing Now. We need to be involved with these groups to make a difference because nurses, by virtue of not just where they work and what they do but by their comprehensive view of health care have a lot to contribute to policy. If policy makers and governments do not take information from the people who actually deliver the care, I’m not sure how they know the right model to apply. Over the past few years ICN has been working closely with WHO on NCDs, PHC and UHC to provide nursing experience to policy and strategy at a global level but this needs to be replicated by nurses being involved in health policy at regional, national and local level. 

“Globally we are 9 million nurses short. This really needs to change if we are ever to achieve UHC. Women are 70% of the global health workforce, mostly working in low-status, low-paid roles.  The UN High Level Meeting on UHC is taking place soon and I would like to see Member States honour their commitment to strengthening the health work force, including finding solutions to the recruitment and of retention nurses. Without nurses, without investing in nurses and improving the conditions of their employment, governments will not retain nurses in the health workforce and therefore never achieve UHC. If you were to take nurses out of the health care you wouldn’t have a health service; there’s no doubt in my mind about that.

“We all - governments, civil society, health professionals and all of us together have a responsibility to promote nursing. The Nursing Now Campaign has been a great support in raising the profile of nurse’s in policy areas and promoting leadership among nurses. Next year, 2020, is an exceptional year because it is designated by WHO as the Year of the Nurse and the Midwife. It is also the 200th anniversary of Florence Nightingale and will also see the publication of the first report on the State of the World’s Nursing, all of which will contribute to raising the profile and status of nursing and ensuring nurses are used to their full potential.

“Dr Tedros, Director General of WHO, at the ICN Congress in Singapore earlier this year, said that the WHO vision cannot be delivered without nurses. Indeed, when nurses are used to their full potential the world will see a difference in how health care is delivered." 

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